Paramedian Craniotomy and Unilateral Anterior Interhemispheric Approach for Clipping of Distal Anterior Cerebral Artery Aneurysm

Indications

• Distal anterior cerebral artery (DACA) aneurysms are usually small with a relatively broad base, are distally located, and have one or more branches originating from their base. These factors tend to favor clipping over endovascular treatment.

• When DACA aneurysms rupture, about 50% manifest with frontal intracranial hemorrhage (ICH). The need for ICH evacuation must be considered when choosing a treatment strategy.

• DACA aneurysms rupture at a smaller size (mean 6 mm) compared with aneurysms in other locations, so treatment of small (< 7 mm), unruptured DACA aneurysms is reasonable in young, healthy patients.

• Patients with poor Hunt and Hess grades of IV or V with ruptured DACA aneurysm should be considered for treatment because mortality for this aneurysm location is lower than for other aneurysms.